Wernicke-Korsakoff syndrome during total parenteral nutrition in a patient with colic ischemia. Case report

Wernicke-Korsakoff syndrome (WKS) is a toxic encephalopathy caused by thiamine (vitamin B1) deficiency, characterized by mental confusion, ataxia and ophthalmoplegia, occurring in alcholics or malnutrition. Thiamine, a structural component of nervous system membranes, is a watersoluble essential vitamin functioning as a coenzyme in carbohydrate metabolism. Adult daily requirement is approximately 1 mg. A malnourished state can produce a thiamine deficiency and alcohol may exacerbate this problem. Infusion of glucose-containing solutions without thiamine supplementation in malnourished patients, initially without symptoms, can cause a iatrogenic Wernicke's encephalopathy. A case of WKS occurring in a non-alcholic malnourished patient with colic ischemia during prolonged intravenous therapy with 5% destrose in water and total parenteral nutrition is reported. An early diagnosis of WKS in neoplastic or malnourished patients, during prolonged total parenteral nutrition, allow a prompt treatment and prevention of neurological complications. In high risk patients it is necessary to start a preventive treatment with 100 mg daily of parenteral thiamine.